Department of Internal Medicine, "Hippokration" General Hospital of Athens, Athens, Greece.
1st Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, "Hippokration" General Hospital, Athens, Greece.
Infect Dis (Lond). 2022 Sep;54(9):692-697. doi: 10.1080/23744235.2022.2072521. Epub 2022 May 12.
Several safe and effective vaccines against nCoV-19 have been developed to contain the pandemic with very few severe adverse-reactions reported. Vaccine-induced interstitial lung disease (ILD) is a very rare and difficult to recognise and diagnose adverse-reaction and is mostly associated with Influenza vaccines.
We report a 55-yr old male who presented with severe respiratory failure that required for several days oxygen supplementation with high flow nasal cannula, and myocardial infarction. Symptoms onset was eighteen days after the first shot of adenoviral AZD1222 vector vaccine. Possible SARS-CoV-2 natural infection post-vaccination was excluded with rigorous laboratory work-up including multiple nasopharengeal rt-qPCR tests for SARS-CoV-2 detection and close monitoring of his serum SARS-CoV-2 antibodies. Other potential infectious agents and alternate diagnoses were thoroughly investigated.
Patient responded impressively to high dose steroids. A repeat chest CT nine days after the first one showed a remarkable resolution of the bilateral ground glass opacities. Except for his cardiology medication, no supplemental oxygen neither steroids were prescribed upon his discharge. On one month follow-up, no residual pulmonary dysfunction was noticed with patient preserving a SatO2 of 97-98% on ambient air.
Vaccine-induced ILD might constitute a rare nCoV-19 post-vaccination adverse-event. According to current restricted data, when post-vaccination ILD is early suspected and recognised, then prompt implementation of steroid treatment reverses significantly the lung lesions without progression to fibrosis.
为了控制大流行，已经开发出几种针对 nCoV-19 的安全有效的疫苗，报告的严重不良反应非常少。疫苗引起的间质性肺病（ILD）是一种非常罕见且难以识别和诊断的不良反应，主要与流感疫苗有关。
我们报告了一名 55 岁男性，他因严重呼吸衰竭而就诊，需要数天高流量鼻导管吸氧，并发生心肌梗死。症状发作是在接种腺病毒 AZD1222 载体疫苗后的第 18 天。通过严格的实验室检查，包括多次鼻咽拭子实时荧光定量 PCR 检测 SARS-CoV-2 以及密切监测其血清 SARS-CoV-2 抗体，排除了疫苗接种后 SARS-CoV-2 自然感染的可能性。彻底调查了其他潜在的感染源和替代诊断。
患者对大剂量类固醇反应良好。第 1 次胸部 CT 后 9 天再次检查显示双侧磨玻璃影明显吸收。除了他的心脏病药物外，出院时未再开具补充氧气或类固醇。在 1 个月的随访中，患者未发现残留的肺功能障碍，在环境空气中血氧饱和度保持在 97-98%。
疫苗引起的 ILD 可能是 nCoV-19 疫苗接种后的罕见不良反应。根据目前的有限数据，当怀疑和及早识别出疫苗接种后 ILD 时，及时实施类固醇治疗可以显著逆转肺部病变，而不会进展为纤维化。
